309-
STEALING IN BULIMIA NERVOSA
W.M.ROWSTON & J. HUBERT LACEY
SUMMARY This clinical study examines the prevalence of stealing and the personal and behavioural factors which distinguish stealing and non-stealing behaviour in a population of 312 female normal-weight bulimics. Bulimic patients who stole had poorer early interpersonal relationships, earlier onset of sexual feelings with greater subsequent sexual activity and increased illicit drug use. The suggestion is made that stealing is a marker of severity. In addition, bulimics who stole appeared to exhibit more obsessional qualities with increased ritualisation.
INTRODUCTION Most
shoplifters
steal for financial
gain.
In Gibbens and Prince’s classic
study
of
Prince, 1962), 20% were found to be suffering from psychiatric shoplifters (Gibbens & illness, particularly depression, when shoplifting is considered to be a ’cry for help’ (Cranston Low, 1983). Crisp et al. (1980) found that 10-15% of anorectics stole, and stealing occurred particularly in the bulimic sub-group. Later Norton et al. (1985) found that the bulimic anorectics who stole tended to be older, more sexually active, and scored higher on measures of free-floating anxiety and depression than those who did not steal. In studies of mixed bulimic groups, some with anorexia nervosa and some at normal weight, between one-third (Krahn et ccl. 1991) and two-thirds (Weiss & Ebert, 1983) report stealing. Stealing was committed more commonly after the onset of binge-eating than before (Pyle et al. 1983). Between a third and two-thirds of patients with bulimia have an associated affective disorder (Hatsukami et al. ]986). The primacy of depression or bulimia in the aetiology of stealing in eating-disordered patients is unclear. In the psychoanalytic literature, stealing has been seen as an ’uncontrollable impulse’, Tiebout, 1932). There is evidence of relieving a feeling of deprivation (Kirkpatrick & ’poor impulse control’ in bulimia nervosa (Weiss & Ebert, 1983). A sub-group of bulimics display a number of ’multi-impulsive symptoms’ which include self-harm (overdoses or &dquo;cutting&dquo;), alcohol and substance abuse as well as stealing (Lacey & Evans, 1986). Many studies have suggested that eating-disordered patients who steal have more disturbed personalities than those who do not (Casper et al. 1980; Igoin-Apfelbaum, 1985), and may be more ’delinquent’ (Norton et cal. 1985). Some studies support this (Igoin-Apfelbaum, 1985; Nogami & Yabana, 1977), while others (Weiss & Ebert, 1983) dispute the assertion that bulimics are more likely to come from a broken home.
Downloaded from isp.sagepub.com at Bobst Library, New York University on May 21, 2015
310
The aim of this study is to examine stealing behaviour in a representative British catchment area (Lacey, 1992a), and in particular to investigate factors which may distinguish stealing bulimic patients from non-stealers.
METHOD
Subjects Three hundred and twelve consecutive female patients were seen at the second author’s bulimia clinic, and diagnosed by DSM-IIIR criteria. A detailed clinic questionnaire, devised to maintain consistency of the interview and which included specific questions on stealing, was completed jointly by the patient and psychiatrist. The results were added to a compressed database. Questions regarding the mental state at presentation were added to the database after the first 1®1 patients, thus this data was available for only 211 patients. The responses of bulimic patients who admitted to a past history of stealing were compared with those patients who denied stealing in the past.
Analysis Subjects replied to a range of questions regarding the history of their eating patterns, family, personal and social history, including social drug use, and mental state at the time of presentation. Statistical comparisons were carried out using the chi-squared test for categorical variables, while Student’s t-test was used for continuous variables.
RESULTS
Forty-two percent of the total sample of patients admitted to a history of stealing. Stealing occurred both before (27%) and after (15%) the onset of binge-eating, with a further 14% describing two discrete episodes both before and after the onset of their eating disorders. Forty-three percent of the stealers could not recall whether the stealing preceded the bulimia or vice versa. Patients were often reluctant to discuss details of their
stealing episodes but we did obtain information about the items stolen from 211 of our patients (see Methods). Items taken were generally food (53%), money (19%), clothes (12%) and cosmetics (5%). Stealing of clothes occurred particularly in those patients who needed to maintain two wardrobes because of their wildly fluctuating size. Money, when stolen, was invariably taken from a parent or family friend. Shop-lifting was the most common activity (43%) but 21 % stole from their families and 7% from school or college.
Symptom pattern Stealers and non-stealers could not be distinguished by the reported pattern of behavioural symptoms, such as self-induced vomiting or laxative abuse; nor could the mean ages, when various symptoms began, differentiate the two groups. A previous history of anorexia nervosa was more commonly reported by stealers (38%) than nonstealers (30%) but this was not significant. The age of presentation at the clinic of the two groups was similar (25.2 years; 24.9 years).
Downloaded from isp.sagepub.com at Bobst Library, New York University on May 21, 2015
,
311
P~~°~®na9 and social background A significantly higher number of stealers reported arguments over food when young (p=0.03). Bulimics who stole had significantly poorer relationships with teachers {p = 0.01 ) and with other children (p = 0.006) at school. In addition, ’stealers’ reported significantly increased truancy (p = 0.0002) and a significantly higher number of major problems with authority (p = 0.01). Although age at menarche in the two groups was similar (Lacey, 1992b), the age of first sexual feelings and awareness of libido occurred at a significantly early age in ’stealers’ (p = 0.042) as did bodily development. Stealers also had significantly more sexual partners (11; 6 partners, p = 0.007) and reported having more &dquo;major&dquo; emotional relationships
(p 0.004). =
The number of ’stealers’ reporting illicit drug use was highly significant (p=0.0001). Cannabis was predominantly used but also other drugs such as amphetamines and cocaine. There were no significant differences between numbers drinking alcohol or smoking, nor in the number of cigarettes smoked per day. Mental state ~t time of presentation (data from 21 patients - see Methods) Ninetyfour percent of patients reported recurrent depressed mood, with no differences between stealers and non-stealers. It may have been expected that the questions relating to sleep disturbance (reported by 60%) and feelings of &dquo;being better off dead&dquo; (reported by 71 %) would have identified a group suffering from more severe depression, but, again, no significant differences emerged between stealers and non-stealers. Stealers and non-stealers reported no differences in answer to the question: &dquo;Do you keep things neat and tidy?&dquo; but a significantly higher proportion of stealers reported using
special rituals to
do this
(p 0.05). =
~IS~I_TS~I®I~
This paper reports the results of the largest study carried out on stealing behaviour in patients with normal-weight bulimia. There was stability of diagnosis in that all were diagnosed by DSM-IIIR criteria and were under the care of a single consultant psychiatrist. Further, all were drawn from the same geographical area which we believe to be representative of an urban catchment area. Forty-two percent of our sample described that they had stolen on at least one occasion. For the majority, stealing was a later development in the illness, tending to occur when the binge-eating was fully established. Some described it as a result of the &dquo;need&dquo; for two wardrobes each of different dress-size; others as a literal necessity to &dquo;feed&dquo; their illness. Rarely was stealing done with the suppressed hope of being caught: the so-called &dquo;cry for help&dquo;(Cranston Low, 1983). A reported past history of anorexia nervosa was not associated with stealing. This, and the similar results reported in studies of anorexia nervosa populations (Caspcr et al. 1980), suggest that stealing is not associated directly with low-weight or anorectic psychopathology but with the occurrence of the binge-eating itself, irrespective of the weight of the patient.
Downloaded from isp.sagepub.com at Bobst Library, New York University on May 21, 2015
312
Two findings in this study are particularly worthy of comment. First, that abuse of drugs amongst bulimics is significantly associated with stealing. Second, that bulimic &dquo;stealers&dquo; report significantly more sexual partners than those who do not steal. Stealing and sexuality were, for a small number, the means of paying for drugs, or at least helping to support their habit. However, for the majority, stealing, binge-eating, drug abuse and sexual disinhibition form part of what the second author has called the multi-impulsive form of bulimia (Lacey & Evans, 1986; Lacey, in press). Each behaviour fluctuates, dominating the clinical picture for a particular time before giving way to another, although judged by the patient to be similarly impulsive and out-of-control. The patients are depressed and angry. This syndrome has also been described in alcoholic (Lacey & Mourelli, 1986; Beary et al. 1986) and drug-abusing groups (Lacey & Evans, 1986). In this study, bulimic patients who stole described poorer interpersonal relationships with teachers and fellow pupils, more truancy and conflict with authority. It was our clinical judgement that these factors reflected a more pervasive personality disorder. Casper et al. (1980) noted that stealing was almost exclusively reported amongst anorectics who binge-ate and who scored higher on the psychopathic deviate scale of the MMPI. Norton et al.’s study (1985) also noted a tendency for general delinquency, on measures of premorbid destructive behaviour, in his anorectics who stole. The results of this study suggest that stealing is a marker of severity and that, when Evans, present, addictive and other self-damaging behaviours should be sought (Lacey & 1986). The evidence that anti-depressants can reduce both bulimic symptoms and stealing (MeElvoy el al, 19$9} suggest that stealing behaviour, within the context of bulimia, is at least in part reversible. An understanding of these processes may reduce the distress which results from arrest for shoplifting, or may be of help in later forming the basis for defence based on medical evidence.
a
legal
REFERENCES
BEARY, M.D., LACEY, J.H. & British Journal
MERRY, J. (1986) Alcoholism and eating disorders in women of fertile age.
of Addiction, 81,
769-774.
CASPER, R.C., ECKERT, E.D., HALMI, K.A., GOLDBERG, S.C. & DAVIS, J.M. (1980) Bulimia - its incidence and clinical importance in patients with anorexia nervosa. Archives of General Psychiatry, 37, 1030-1035. CRANSTON LOW, N. (1983) Neither guilty nor insane. Medicine, Science and Law, 23:4, 275-278. CRISP, A.H., HSU, L.K.G. & HARDING, B. (1980) The starving hoarder and voracious spender: stealing in anorexia nervosa. Journal of Psychosomatic Research, 24, 225-231. GIBBENS, T.N. & PRINCE, J. (1962). Shoplifting. Institute for Study and Treatment of Delinquency, London HATSUKAMI, D., MITCHELL, J.E., ECKERT, E.D. & PYLE, R. (1986) Characteristics of patients with bulimia only, bulimia with affective disorder, and bulimia with substance abuse problems. Addictive Behaviours, 11, 399-406. IGOIN-APFELBAUM, L. (1985) Characteristics of family background in bulimia. Psychotherapy & Psychosomatics, 43, 161-167. KIRKPATRICK, M. & TIEBOUT, H. (1932) Psychiatric factors in stealing. American Journal of Orthopsychiatry, II, 114. KRAHN, D.D., NAIRN, K., GOSNELL, B.A. & DREWNOWSKI, A. (1991) Stealing in eating disordered patients. Journal of Clinical Psychiatry, 52:3, 112-115. LACEY, J.H. & EVANS, C.D.H. (1986) The impulsivist: a multi-impulsive personality disorder. Britislz.dournal of Addiction, 81, 641-649. LACEY, J.H. & MOURELLI, E. (1986) Bulimic alcoholics: some features of a clinical sub-group. British Journal of Addiction, 81, 389-393.
Downloaded from isp.sagepub.com at Bobst Library, New York University on May 21, 2015
313
LACEY, J.H. (1992a) The
treatment demand for bulimia:
a
catchment
area
report of referral
rates and
demography. Psychiatric Bulletin of the British Journal of Psychiatry, 16, 203-205. LACEY, J.H. (1992b) A comparative study of menarchal age and weight of bulimic patients and their sisters. International Journal of Eating Disorders (in press). LACEY, J.H. Self darnaging and addictive behaviour in bulimia nervosa: a catchment area study (in press). HUDSON, J. (1989) Pharmacological treatment of McELVOY, S.L., KECH, P.E., POPE, H.G. & kleptomania and bulimia nervosa. Journal of Clinical Psychopharmacology, 9:5, 358-360. NOGAMI, Y. & YABANA, F. (1977) On kibarashi-gui (binge-eating). Folia Psychiatrica Neurologica Japonica, 31, 159-166. NORTON, K.R.W., CRISP, A.H. & BHAT, A.V. (1985) Why do some anorectics steal? Personal, social and illness factors. Journal of Psychiatric Research, 19:2/3, 385-390. PYLE, R.L., MITCHELL, J.E., ECKERT, M. ET AL. (1983) The incidence of bulimia in freshman college students. International Journal of Eating Disorders, 2, 75-85. WEISS, S. & EBERT, M. (1983) Psychological and behavioural characteristics of normal-weight bulimics and normal-weight controls. Psychosomatic Medicine, 45, 293-303.
Rowston, MRCPsych, Department of Mental Health Sciences, St. George’s Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK. Professor J. Hubert Lacey, FRCPsych, Head, Division of General Psychiatry, Department of Mental Health Sciences, St. George’s Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK. Dr. W.M.
Correspondence
to
Professor
Lacey
Downloaded from isp.sagepub.com at Bobst Library, New York University on May 21, 2015
STEALING IN BULIMIA NERVOSA
W.M.ROWSTON & J. HUBERT LACEY
SUMMARY This clinical study examines the prevalence of stealing and the personal and behavioural factors which distinguish stealing and non-stealing behaviour in a population of 312 female normal-weight bulimics. Bulimic patients who stole had poorer early interpersonal relationships, earlier onset of sexual feelings with greater subsequent sexual activity and increased illicit drug use. The suggestion is made that stealing is a marker of severity. In addition, bulimics who stole appeared to exhibit more obsessional qualities with increased ritualisation.
INTRODUCTION Most
shoplifters
steal for financial
gain.
In Gibbens and Prince’s classic
study
of
Prince, 1962), 20% were found to be suffering from psychiatric shoplifters (Gibbens & illness, particularly depression, when shoplifting is considered to be a ’cry for help’ (Cranston Low, 1983). Crisp et al. (1980) found that 10-15% of anorectics stole, and stealing occurred particularly in the bulimic sub-group. Later Norton et al. (1985) found that the bulimic anorectics who stole tended to be older, more sexually active, and scored higher on measures of free-floating anxiety and depression than those who did not steal. In studies of mixed bulimic groups, some with anorexia nervosa and some at normal weight, between one-third (Krahn et ccl. 1991) and two-thirds (Weiss & Ebert, 1983) report stealing. Stealing was committed more commonly after the onset of binge-eating than before (Pyle et al. 1983). Between a third and two-thirds of patients with bulimia have an associated affective disorder (Hatsukami et al. ]986). The primacy of depression or bulimia in the aetiology of stealing in eating-disordered patients is unclear. In the psychoanalytic literature, stealing has been seen as an ’uncontrollable impulse’, Tiebout, 1932). There is evidence of relieving a feeling of deprivation (Kirkpatrick & ’poor impulse control’ in bulimia nervosa (Weiss & Ebert, 1983). A sub-group of bulimics display a number of ’multi-impulsive symptoms’ which include self-harm (overdoses or &dquo;cutting&dquo;), alcohol and substance abuse as well as stealing (Lacey & Evans, 1986). Many studies have suggested that eating-disordered patients who steal have more disturbed personalities than those who do not (Casper et al. 1980; Igoin-Apfelbaum, 1985), and may be more ’delinquent’ (Norton et cal. 1985). Some studies support this (Igoin-Apfelbaum, 1985; Nogami & Yabana, 1977), while others (Weiss & Ebert, 1983) dispute the assertion that bulimics are more likely to come from a broken home.
Downloaded from isp.sagepub.com at Bobst Library, New York University on May 21, 2015
310
The aim of this study is to examine stealing behaviour in a representative British catchment area (Lacey, 1992a), and in particular to investigate factors which may distinguish stealing bulimic patients from non-stealers.
METHOD
Subjects Three hundred and twelve consecutive female patients were seen at the second author’s bulimia clinic, and diagnosed by DSM-IIIR criteria. A detailed clinic questionnaire, devised to maintain consistency of the interview and which included specific questions on stealing, was completed jointly by the patient and psychiatrist. The results were added to a compressed database. Questions regarding the mental state at presentation were added to the database after the first 1®1 patients, thus this data was available for only 211 patients. The responses of bulimic patients who admitted to a past history of stealing were compared with those patients who denied stealing in the past.
Analysis Subjects replied to a range of questions regarding the history of their eating patterns, family, personal and social history, including social drug use, and mental state at the time of presentation. Statistical comparisons were carried out using the chi-squared test for categorical variables, while Student’s t-test was used for continuous variables.
RESULTS
Forty-two percent of the total sample of patients admitted to a history of stealing. Stealing occurred both before (27%) and after (15%) the onset of binge-eating, with a further 14% describing two discrete episodes both before and after the onset of their eating disorders. Forty-three percent of the stealers could not recall whether the stealing preceded the bulimia or vice versa. Patients were often reluctant to discuss details of their
stealing episodes but we did obtain information about the items stolen from 211 of our patients (see Methods). Items taken were generally food (53%), money (19%), clothes (12%) and cosmetics (5%). Stealing of clothes occurred particularly in those patients who needed to maintain two wardrobes because of their wildly fluctuating size. Money, when stolen, was invariably taken from a parent or family friend. Shop-lifting was the most common activity (43%) but 21 % stole from their families and 7% from school or college.
Symptom pattern Stealers and non-stealers could not be distinguished by the reported pattern of behavioural symptoms, such as self-induced vomiting or laxative abuse; nor could the mean ages, when various symptoms began, differentiate the two groups. A previous history of anorexia nervosa was more commonly reported by stealers (38%) than nonstealers (30%) but this was not significant. The age of presentation at the clinic of the two groups was similar (25.2 years; 24.9 years).
Downloaded from isp.sagepub.com at Bobst Library, New York University on May 21, 2015
,
311
P~~°~®na9 and social background A significantly higher number of stealers reported arguments over food when young (p=0.03). Bulimics who stole had significantly poorer relationships with teachers {p = 0.01 ) and with other children (p = 0.006) at school. In addition, ’stealers’ reported significantly increased truancy (p = 0.0002) and a significantly higher number of major problems with authority (p = 0.01). Although age at menarche in the two groups was similar (Lacey, 1992b), the age of first sexual feelings and awareness of libido occurred at a significantly early age in ’stealers’ (p = 0.042) as did bodily development. Stealers also had significantly more sexual partners (11; 6 partners, p = 0.007) and reported having more &dquo;major&dquo; emotional relationships
(p 0.004). =
The number of ’stealers’ reporting illicit drug use was highly significant (p=0.0001). Cannabis was predominantly used but also other drugs such as amphetamines and cocaine. There were no significant differences between numbers drinking alcohol or smoking, nor in the number of cigarettes smoked per day. Mental state ~t time of presentation (data from 21 patients - see Methods) Ninetyfour percent of patients reported recurrent depressed mood, with no differences between stealers and non-stealers. It may have been expected that the questions relating to sleep disturbance (reported by 60%) and feelings of &dquo;being better off dead&dquo; (reported by 71 %) would have identified a group suffering from more severe depression, but, again, no significant differences emerged between stealers and non-stealers. Stealers and non-stealers reported no differences in answer to the question: &dquo;Do you keep things neat and tidy?&dquo; but a significantly higher proportion of stealers reported using
special rituals to
do this
(p 0.05). =
~IS~I_TS~I®I~
This paper reports the results of the largest study carried out on stealing behaviour in patients with normal-weight bulimia. There was stability of diagnosis in that all were diagnosed by DSM-IIIR criteria and were under the care of a single consultant psychiatrist. Further, all were drawn from the same geographical area which we believe to be representative of an urban catchment area. Forty-two percent of our sample described that they had stolen on at least one occasion. For the majority, stealing was a later development in the illness, tending to occur when the binge-eating was fully established. Some described it as a result of the &dquo;need&dquo; for two wardrobes each of different dress-size; others as a literal necessity to &dquo;feed&dquo; their illness. Rarely was stealing done with the suppressed hope of being caught: the so-called &dquo;cry for help&dquo;(Cranston Low, 1983). A reported past history of anorexia nervosa was not associated with stealing. This, and the similar results reported in studies of anorexia nervosa populations (Caspcr et al. 1980), suggest that stealing is not associated directly with low-weight or anorectic psychopathology but with the occurrence of the binge-eating itself, irrespective of the weight of the patient.
Downloaded from isp.sagepub.com at Bobst Library, New York University on May 21, 2015
312
Two findings in this study are particularly worthy of comment. First, that abuse of drugs amongst bulimics is significantly associated with stealing. Second, that bulimic &dquo;stealers&dquo; report significantly more sexual partners than those who do not steal. Stealing and sexuality were, for a small number, the means of paying for drugs, or at least helping to support their habit. However, for the majority, stealing, binge-eating, drug abuse and sexual disinhibition form part of what the second author has called the multi-impulsive form of bulimia (Lacey & Evans, 1986; Lacey, in press). Each behaviour fluctuates, dominating the clinical picture for a particular time before giving way to another, although judged by the patient to be similarly impulsive and out-of-control. The patients are depressed and angry. This syndrome has also been described in alcoholic (Lacey & Mourelli, 1986; Beary et al. 1986) and drug-abusing groups (Lacey & Evans, 1986). In this study, bulimic patients who stole described poorer interpersonal relationships with teachers and fellow pupils, more truancy and conflict with authority. It was our clinical judgement that these factors reflected a more pervasive personality disorder. Casper et al. (1980) noted that stealing was almost exclusively reported amongst anorectics who binge-ate and who scored higher on the psychopathic deviate scale of the MMPI. Norton et al.’s study (1985) also noted a tendency for general delinquency, on measures of premorbid destructive behaviour, in his anorectics who stole. The results of this study suggest that stealing is a marker of severity and that, when Evans, present, addictive and other self-damaging behaviours should be sought (Lacey & 1986). The evidence that anti-depressants can reduce both bulimic symptoms and stealing (MeElvoy el al, 19$9} suggest that stealing behaviour, within the context of bulimia, is at least in part reversible. An understanding of these processes may reduce the distress which results from arrest for shoplifting, or may be of help in later forming the basis for defence based on medical evidence.
a
legal
REFERENCES
BEARY, M.D., LACEY, J.H. & British Journal
MERRY, J. (1986) Alcoholism and eating disorders in women of fertile age.
of Addiction, 81,
769-774.
CASPER, R.C., ECKERT, E.D., HALMI, K.A., GOLDBERG, S.C. & DAVIS, J.M. (1980) Bulimia - its incidence and clinical importance in patients with anorexia nervosa. Archives of General Psychiatry, 37, 1030-1035. CRANSTON LOW, N. (1983) Neither guilty nor insane. Medicine, Science and Law, 23:4, 275-278. CRISP, A.H., HSU, L.K.G. & HARDING, B. (1980) The starving hoarder and voracious spender: stealing in anorexia nervosa. Journal of Psychosomatic Research, 24, 225-231. GIBBENS, T.N. & PRINCE, J. (1962). Shoplifting. Institute for Study and Treatment of Delinquency, London HATSUKAMI, D., MITCHELL, J.E., ECKERT, E.D. & PYLE, R. (1986) Characteristics of patients with bulimia only, bulimia with affective disorder, and bulimia with substance abuse problems. Addictive Behaviours, 11, 399-406. IGOIN-APFELBAUM, L. (1985) Characteristics of family background in bulimia. Psychotherapy & Psychosomatics, 43, 161-167. KIRKPATRICK, M. & TIEBOUT, H. (1932) Psychiatric factors in stealing. American Journal of Orthopsychiatry, II, 114. KRAHN, D.D., NAIRN, K., GOSNELL, B.A. & DREWNOWSKI, A. (1991) Stealing in eating disordered patients. Journal of Clinical Psychiatry, 52:3, 112-115. LACEY, J.H. & EVANS, C.D.H. (1986) The impulsivist: a multi-impulsive personality disorder. Britislz.dournal of Addiction, 81, 641-649. LACEY, J.H. & MOURELLI, E. (1986) Bulimic alcoholics: some features of a clinical sub-group. British Journal of Addiction, 81, 389-393.
Downloaded from isp.sagepub.com at Bobst Library, New York University on May 21, 2015
313
LACEY, J.H. (1992a) The
treatment demand for bulimia:
a
catchment
area
report of referral
rates and
demography. Psychiatric Bulletin of the British Journal of Psychiatry, 16, 203-205. LACEY, J.H. (1992b) A comparative study of menarchal age and weight of bulimic patients and their sisters. International Journal of Eating Disorders (in press). LACEY, J.H. Self darnaging and addictive behaviour in bulimia nervosa: a catchment area study (in press). HUDSON, J. (1989) Pharmacological treatment of McELVOY, S.L., KECH, P.E., POPE, H.G. & kleptomania and bulimia nervosa. Journal of Clinical Psychopharmacology, 9:5, 358-360. NOGAMI, Y. & YABANA, F. (1977) On kibarashi-gui (binge-eating). Folia Psychiatrica Neurologica Japonica, 31, 159-166. NORTON, K.R.W., CRISP, A.H. & BHAT, A.V. (1985) Why do some anorectics steal? Personal, social and illness factors. Journal of Psychiatric Research, 19:2/3, 385-390. PYLE, R.L., MITCHELL, J.E., ECKERT, M. ET AL. (1983) The incidence of bulimia in freshman college students. International Journal of Eating Disorders, 2, 75-85. WEISS, S. & EBERT, M. (1983) Psychological and behavioural characteristics of normal-weight bulimics and normal-weight controls. Psychosomatic Medicine, 45, 293-303.
Rowston, MRCPsych, Department of Mental Health Sciences, St. George’s Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK. Professor J. Hubert Lacey, FRCPsych, Head, Division of General Psychiatry, Department of Mental Health Sciences, St. George’s Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK. Dr. W.M.
Correspondence
to
Professor
Lacey
Downloaded from isp.sagepub.com at Bobst Library, New York University on May 21, 2015
